Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
1 | 208100000X | Physical Medicine & Rehabilitation | | 18941 | MARYLAND | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
1 | 604235-03 | OTHER | MARYLAND | MSS CAREFIRST |
2 | 123MO44F | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | FREDERICK SPORT & SPINE |
3 | S81582 | MEDICARE UPIN | MARYLAND | |
4 | 034NK717 | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | MIDDLETOWN SPORT & SPINE |
5 | 551810 | OTHER | MARYLAND | FSS MAMSI |
6 | 2511558 | OTHER | MARYLAND | UHC MSS |
7 | R5590001 | OTHER | MARYLAND | FSS BC FEP |
8 | 2004876 | OTHER | MARYLAND | UHC FSS |
9 | 604235-02 | OTHER | MARYLAND | CAREFIRST |
10 | K1340004 | OTHER | MARYLAND | MSS BC |
11 | 443703 | OTHER | MARYLAND | MSS MAMSI |
12 | 334552 | OTHER | MARYLAND | PHCS |